Cardiology - Acute Coronary Syndrome Medications Flashcards
Heparin in ACS
? mechanism
Binds to and potentiates antithrombin to inactivate Xa
- -> prevents prothrombin to thrombin
- -> prevents fibrinogen to fibrin
Enhances antithrombin effect on Factor Xa and Thrombin.
No renal clearance
Enoxaparin in ACS
? difference to heparin
Enhances antithrombin effect more selectively for Factor Xa than heparin
Half life 4-7.5 hours
FAVOURED compared to UFH in ACS
Fondaparinux in ACS
Causes Antithrombin III mediated selective inhibition of Factor Xa
Specific for AntiThrombin
Renally cleared with long half life 17-21 hours
Bivalirudin MoA used in ACS
SPECIFIC and REVERSIBLE direct thrombin inhibitor
Therefore prevents thrombin mediated fibrinogen to fibrin
Abciximab
Antibody fragmant that binds to IIb/IIIa Receptors
RAPID ONSET <10 minutes
HALF LIFE 8-12 hours
No renal dose effects
Beta Blocker use in ACS
Beta blockers used as Anti-Anginal
Use intravenous if persistent signs and symptoms
Beta blockers IMPROVE myocardial O2 supply-demand and result in:
- decreased PAIN
- decreased INFARCT SIZE
- decreased incidence of serious arrythmias
Statin use in ACS
High dose ATORVASTATIN and ROSUVASTATIN improve 2 year survival
Early administration BEFORE PCI (atorvastatin 80mg) reduces complications of procedure and recurrence of ACS
ACE inhibitor in ACS (which ONE ACEi has evidence)
Ramipril may have post ACS cardioprotective effects
Primary VT prophylaxis post ACS?
Post AMI beta blocker reduces VT and SCD
BUT no other anti-arrythmics are beneficial
